Roundtables and Panel Discussions Plunge into Ethics, Advancements in Biomedicine
Researchers, innovators, journalists, collaborators and patients shared insights on topics ranging from weight loss strategies to confronting opioid addiction to fighting cancer. Panelists and audience members took on tough questions around ethics, privacy and disparities in genomic medicine. A patient shared his life-changing experience of receiving a lung transplant made possible for Ex Vivo Lung Perfusion. A preeminent expert on sleep shared evidence-based tips on how to sleep better at night. A request for important research considerations at the gender-informed medicine session yielded a wall full of audience responses. Read on to catch these moments and more, highlighted by CRN’s staff.
Experts Weight In
Florencia Halperin, MD, MMSc, Marie McDonnell, MD, and Ali Tavakkoli, MD, engaged the audience in a conversation about evidence-based weight loss strategies, nutrition and the associated clinical and research aspects of keeping the weight off.
- Obesity affects nearly one third of adults in the United States.
- Panelists presented a case study of a female patient with type 2 diabetes, high blood pressure and knee osteoarthritis and had a body mass index (BMI) of 60 when she came to the Center for Weight Management and Metabolic Surgery; a score over 30 being considered clinically obese. Halperin and Tavakkoli described how the team first attempted to help her achieve weight loss through lifestyle modifications and medication. Ultimately, the patient saw the most success with surgery, dropping to a BMI of 49.
- Tavakkoli paused to ask an age-old question: Is breakfast truly the most important meal of the day? Or is it simply a successful marketing slogan by breakfast cereal manufacturers? After a spirited debate among attendees, panelists acknowledge that there is no clear, consistent evidence either way for the general population.
- Kathy McManus, MS, RD, LDN, director of the Department of Nutrition, noted that there is one study that found 77 percent of participants who were successful in maintaining lost weight over a period of time reported that they ate breakfast five or more times a week. Halperin added that studies have found breakfast is important for children, improving concentration and performance at school
Long Live the Lung
Clinicians and researchers at the Brigham Lung Center are expanding options for lung transplant recipients by increasing the number of organs available, and improving the viability of donor lungs. The Lung Center’s Raphael Bueno, MD, and Bruce D. Levy, MD, led a lively discussion about Ex Vivo Lung Perfusion (EVLP), a tool that improves the quality of donor lungs and their condition for transplantation. A patient of the BWH Lung Center, Jason Crowell, also spoke about his experience undergoing EVLP. The panel also included the Lung Center’s Steven P. Keller, MD, PhD; Antonio Coppolino, III, MD, MSc; Hari Reddy Mallidi, MD.
- Ex Vivo Lung Perfusion (EVLP) is a pump system that allows donor lungs to be evaluated and reconditioned. The lungs are connected to a ventilator for about three hours while the lung’s potential for transplant is evaluated for demonstrated ability to deflate and reinflate, deliver oxygen and function without sustaining injury.
- Only 15 percent of donor lungs are suitable for transplantation. With far more patients awaiting lung transplant than there are available lungs, new technologies are needed to evaluate and sustain lungs that may have life-saving potential.
- Patient Jason Crowell received a successful lung transplant in February after donor lungs were evaluated and reconditioned using EVLP. The transplant saved his life and has restored his health, he said: “The best part came on October 29, celebrating my son’s 5th birthday.”
- Keller: Using this type of technology, we hope to salvage more lungs to save more patients’ lives.
- Mallidi: So far, Brigham has evaluated 10 donor lungs. Jason is one of two recipients to date who has received EVLP-reconditioned lungs at the Brigham. About 100 patients in the U.S. and Canada have received transplants of EVLP-reconditioned lungs.
Women are Not Men
Hadine Joffe, MD, MSc, Ursula Kaiser, MD, and Kathryn M. Rexrode, MD, MPH, discussed the diseases women are at risk for across their lifespan and the available resources that are tailored specifically to women such as The Connors – BRI Center for Research on Women’s Health and Gender Biology, which focuses on life-stages specific to women that explain sex differences in morbidity, mortality, and certain disorders.
- An audience member noted: “There is a trend in this room right now [almost all attendees were women], we need to include men in the conversation.”
- What are the major gaps in research of sex differences right now? We tend to think solely about hormones but there are many other factors involved such as genetics, autoimmunity, metabolism, brain differences, vascular differences, etc.
- Most previous research has been conducted on males, not females, so there are huge gaps in knowledge when looking at sex differences.
The audience was asked to name one important research consideration given sex differences:
No Wrong Door
Emergency Medicine physician Scott Weiner, MD, MPH, (@ScottWeinerMD) and moderator Maggie Penman (@maggiepenman) led a discussion about the Brigham treatment programs and specialized approaches clinicians take in confronting opioid addiction. One exciting new resource is The Brigham Health Bridge Clinic, which connects patients who have substance abuse disorders with the long-term care. Panelists include the Bridge Clinic’s Christin Price, MD, (@ChristinPrice) and psychiatrist Joji Suzuki, MD.
- Weiner: The number of people we were treating for overdoses and the national numbers just kept going up – we realized we had to do something. We set out to form a hospital-wide program.
- Suzuki: of all patients who could benefit from treatment for substance abuse disorder, only 7 percent are receiving it; most hospitals do not provide addiction treatment
- Price: Even one day can be too long. Today, when a patient lands in the ED, we can walk them right over to the Bridge Clinic.
- More details on the Bridge Clinic can be found here.
Boning Up on the Connection Between Muscle and Bone
Julia Charles, MD, PhD, and Ronald L. Neppl, PhD, of the Orthopaedics Department, led a discussion about innovative research pertaining to muscles and bone healing. Discussants included Indranil Sinha, MD, of Trauma, Burns and Critical Care; Michael J. Weaver, MD, of Orthopaedics; Paul Yu, MD, PhD (@bmprii), of the Cardiovascular Division.
- There are over 600 muscles and 200 bones in the human body
- Researchers still do not fully understand how muscles and bones communicate during important processes such as healing
- Bone is one of the few tissues in the body that can heal without a scar
- We currently do not have any ways to speed up the process of bone healing after a bone break or fracture.
- 5-10 percent of fractures are nonunion and fail to heal
- “Restoring full function to both bone and muscle after a major traumatic event is an unmet need in medicine.” – Indranil Sinha, MD
Sleep Well, Live Well
We joined the Sleep Division’s Charles A. Czeisler, MD, PhD, as he spoke about the risks of sleep deprivation and suggests valuable tools and techniques to improve a person’s sleep using evidence-based interventions.
- Sleep deficiency epidemic: 50-70 million Americans suffer from chronic sleep disorders; 69 perfect of Americans report regularly getting insufficient sleep.
- It also contributes to the 6,400 fatalities that occur annually due to fatigue-related car accidents.
- Tip for restful slumber: Go to sleep when you’re truly tired. Struggling to fall asleep leads to frustration. If you’re not asleep after 20 minutes, get out of bed, go to another room and do something relaxing, like reading or listening to music until you’re tired enough to sleep.
- Tip for restful sleep: Lighten up evening meals – Eating a pizza at 10 p.m. may be a recipe for insomnia. Finish dinner several hours before bedtime and avoid foods that cause indigestion. If you get hungry at night, snack on foods that in your experience won’t disturb your sleep, such as dairy foods and carbs.
- Sleep stealers: electronics, alcohol (it takes two hours to metabolize each serving of alcohol), caffeine, light exposure (bathroom lights, for example), pets (recommend keeping out of bedroom during sleep time).
Human Models to Study Human Diseases
Gerald B. Pier, MA, PhD, of the Division of Infectious Diseases, led a discussion with Yemi Talabi-Oates, MBA, administrative director for the Center for Clinical Investigation, about the possibility of opening a human disease challenges center at the Brigham. This center would allow for voluntary testing on human subjects in a safe and controlled manner to advance the development of life-saving drugs.
- Many organizations are already using human infectious disease challenge models to study infectious viruses and diseases such as Norovirus and tuberculosis
- Brigham researchers have a wide range of interests including finding better treatments for HIV and flu.
- “I hope the focus will be on bringing translational technologies – antibodies, vaccines – out of the lab and into some actual testing to help people.”- Gerald B. Pier, MA, PhD
Cancer in the Crosshairs
Pathologist Jon C. Aster, MD, PhD, and Elizabeth Henske, MD, of the Pulmonary Division, led a discussion about diagnostic advances and innovations that are being applied at the Brigham to improve the chances of early cancer detection and allow for a personalized medicine approach for individuals with cancer.
- Panelists included pathologist Scott J. Rodig, MD, PhD; Clare Mary Tempany-Afdhal, MD, the Medical Director of the Advanced Multimodal Image-Guided Operating (AMIGO) suite; and David R. Walt, PhD, of the Department of Pathology
- Rodig: this seems to be an era of revolution in cancer care; it’s been established that patients’ immune systems can recognize their cancers but cancers use tricks to avoid detection. New therapies can rev up the immune system and help eradicate cancer cells.
- Over the last 10 years, tremendous success has occurred in cancers such as melanoma and metastatic lung cancer, but why don’t all patients have success?
- Can diagnosticians figure out which patients’ cancers will be able to resist treatment and through which mechanisms? How can we combat/overcome these tricks?
- Walt: we want to be able to compare people to their healthy selves – we’re developing ultrasensitive tech to probe molecules that we think will be particularly prognostic; there’s lots more to do, but what we’ve seen so far gives us hope
- Tempany: we’re developing new imaging tools to bring to the operating room and bedside to guide procedures. Imaging can also inform needle biopsies – where to place the needle – and contribute to early detection.
This session focused on The Brigham Care Redesign Incubator and the Startup Program (BCRISP), which aims to improve patient care by investing in innovative proposals from Brigham clinicians and researchers.
- Moderated by Gideon Gil, Managing Editor of STAT News, this panel joined together members of BCRISP, iHub and Herald Health, to discuss first hand experiences, of successfully growing and piloting here at the Brigham, and how they found collaboration and communication was key to navigating a large academic medical center.
- Primary care physician Karl Laskowski, MD, leads BCRISP, which invests in innovative proposals from front-line clinicians, rapidly test pilots, scales successful projects, and creates programs that ultimately deliver clinical and financial value.
- Since its launch in 2013, over 70 projects have been funded through BCRISP. It’s an atypical program among academic medical centers, but one that Brigham and Women’s is proud to offer for front-line clinicians and researchers.
- Innovations from BCRISP have reduced costs by $1.8 million per year in total medical expenses.
- Josie Elias is a program manager for Digital Health Innovation for the Brigham Digital Innovation Hub. iHub helps internal innovators further their ideas and concepts. Most importantly navigate the complexity within a large academic medical center. This creates an abundance of opportunity, both the plethora of ideas and engagement with digital health startups.
- “It has been primarily clinician and researcher driven. If there is a strong value and concrete metrics, iHub can help support a project.“ – Elias on how iHub selects the ideas and startups they chose to work with to move to the next stage.
- Herald Health co-founder Brad Diephuis, MD, went into detail explaining how this digital health company got started. Coming together originally in an iHub hackathon, iHub helped transform Herald Health from just an idea, into a product with clear value proposition to the hospital. Diephuis also talked about finding a specific use case for Herald Health through conversations with Laskowski. Overall, BCRISP’s value contribution includes coaching, funding, and visibility to leadership.
- Laskowski and Elias gave their advice for companies and startups wanting to work with AMCS: “Think about if an academic medical center is the place to start your first pilot. Have you thought about smaller, community hospitals?”, “Know your long-term strategy and have defined metrics.”
- Visit @BWHiHub for more coverage of the panel.
Trauma and Violence
Senior Nurse Scientist Annie-Lewis O’Connor, PhD, NP-BC, MPH, FAAN led a discussion with Brigham experts on mental health, intimate partner violence and the way the brain responds to trauma such as gun violence and domestic abuse. Panelists included Elzerie de Jager, MBBS, of the Department of Surgery; Bharti Khurana, MD, of the Department of Radiology; Alexander Lin, PhD, of the Department of Radiology; and Eve Rittenberg, MD, MA, of the Fish Center for Women’s Health.
- One in four women and one in seven men have reported experiencing severe physical violence from an intimate partner in their lifetime in the U.S.
- Khurana wants to create a tool to track recurrent bone breaks to help more people in traumatic relationships
- “We want to help survivors of trauma access care to increase their health and wellbeing.” – Eva Rittenberg, MD, MA
A Community Conversation on Equity in Precision Medicine
This session, led by Elizabeth Karlsson, MD, MMSc, focused on the All of Us Research Program – an ambitious initiative to create a research community of one million people or more who are willing to share their unique health data with researchers. The roundtable prompted hard-hitting questions about privacy and discussants offered suggestions as to how they can be addressed. The panel included Jonathan Jackson, PhD from MGH; Elizabeth W. Karlson, MD, MMSc, of the Brigham’s Division of Rheumatology, Immunology and Allergy; and Latrice Landry, PhD, MMSc, of the Department of Pathology.
- More than 7,000 people in New England have enrolled in All of Us, including underrepresented populations
- Greater than 71 percent of genetic studies are based off of people of European ancestry but only 15 percent of the world’s population is of European ancestry
- We have gaps to fill: When it comes to precision medicine, there’s a lot of noise.
- Karlson described looking at how the environment interacts with our gene as well as prevention: How can we take the data, piece things together and prevent disease?
- Jackson asks the room: “What do you think of All of Us based on what you’ve heard so far?” Audience has questions – is it invasive? What about privacy? Jackson describes strict encryption, state-of-the-art privacy. “Frankly, it’s safer than the information you give to Facebook, Instagram on a daily basis.”
- More about All of Us here: https://allofus.nih.gov/